Psychoactive Drugs Tobacco, Alcohol, and Illicit Substances

7. Conclusions

The source document for this Digest states:

This report has summarized the advances in our understanding of the neuroscience of psychoactive substance use and dependence in recent decades, and has considered some of the ethical issues which are connected with these advances. The developments in neuroscience have greatly increased our knowledge about substance use and dependence, and the new knowledge poses substantial challenges for us to make ethical choices in applying the fruits of this knowledge, both globally and locally. Relevant organizational and professional bodies should play a leading role in meeting these challenges at global and regional levels.

A substantial portion of the global burden of disease and disability is attributable to psychoactive substance use. In turn, a substantial portion of the burden attributable to substance use is associated with dependence. Tobacco and alcohol use are particularly prominent contributors to the total burden. Measures to reduce the harm from tobacco, alcohol and other psychoactive substances are thus an important part of health policy.

Neuroscience is a fast growing field of scientific research. Though the knowledge base is far from complete, there is a considerable amount of useful data with enormous potential for influencing policies to reduce the burden of disease and disability associated with substance use. The following recommendations are made to facilitate greater openness and assist all stakeholders in mobilizing action:

All psychoactive substances can be harmful to health, depending on how they are taken, in which amounts and how frequently. The harm differs between substances and the public health response to substance use should be proportional to the health-related harm that they cause

Use of psychoactive substances is to be expected because of their pleasurable effects as well as peer pressure and the social context of their use. Experimentation does not necessarily lead to dependence but the greater the frequency and amount of substance used, the higher the risk of becoming dependent.

Harm to society is not only caused by individuals with substance dependence. Significant harm also comes from non dependent individuals, stemming from acute intoxication and overdoses, and from the form of administration (e.g. through unsafe injections). There are, however, effective public health policies and programmes which can be implemented and which will lead to a significant reduction in the overall burden related to substance use.

Substance dependence is a complex disorder with biological mechanisms affecting the brain and its capacity to control substance use. It is not only determined by biological and genetic factors, but psychological, social, cultural and environmental factors as well. Currently, there are no means of identifying those who will become dependent - either before or after they start using drugs.

Substance dependence is not a failure of will or of strength of character but a medical disorder that could affect any human being. Dependence is a chronic and relapsing disorder, often co-occurring with other physical and mental conditions.

There is significant comorbidity of substance dependence with various other mental illnesses; assessment, treatment and research would be most effective if an integrated approach were adopted. Treatment and prevention insights from other mental illnesses or substance dependence can be used to inform treatment and prevention strategies in the domain of the other. Attention to comorbidity of substance use disorders and other mental disorders is thus required as an element of good practice in treating or intervening in either mental illness or substance dependence.

Treatment for substance dependence is not only aimed at stopping drug use - it is a therapeutic process that involves behaviour changes, psychosocial interventions and often, the use of substitute psychotropic drugs. Dependence can be treated and managed cost-effectively, saving lives, improving the health of affected individuals and their families, and reducing costs to society.

Treatment must be accessible to all in need. Effective interventions exist and can be integrated into health systems, including primary health care. The health care sector needs to provide the most cost-effective treatments.

One of the main barriers to treatment and care of people with substance dependence and related problems is the stigma and discrimination against them. Regardless of the level of substance use and which substance an individual takes, they have the same rights to health, education, work opportunities and reintegration into society, as does any other individual.

Investments in neuroscience research must continue and expand to include investments in social science, prevention, treatment and policy research. The reduction in the burden from substance use and related disorders must rely on evidence-based policies and programmes which are the result of research and its application

Finally, emerging technologies and therapies to prevent and treat dependence and related problems pose difficult ethical issues. These issues should be addressed by national and international scientific and policy communities as a priority.